Functional Tricuspid Regurgitation and Right Atrial Remodeling in Heart Failure With Preserved Ejection Fraction
| Autor: | Toshihisa Anzai, Toshimitsu Kato, Kuniko Yoshida, Masahiko Kurabayashi, Barry A. Borlaug, Hiroyuki Iwano, Toshiyuki Nagai, Tomonari Harada, Takahiro Ikoma, Kenya Okada, Masaru Obokata, Koji Kurosawa, Kazunori Omote |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Regurgitation (circulation) Right atrial Severity of Illness Index Functional tricuspid regurgitation Risk Factors Internal medicine medicine Humans In patient cardiovascular diseases Aged Retrospective Studies Aged 80 and over Heart Failure Vena contracta business.industry Stroke Volume Atrial Remodeling Middle Aged Tricuspid Valve Insufficiency Hospitalization Blood pressure Echocardiography cardiovascular system Cardiology Dilation (morphology) Female Cardiology and Cardiovascular Medicine Heart failure with preserved ejection fraction business |
| Zdroj: | The American journal of cardiology. 162 |
| ISSN: | 1879-1913 |
| Popis: | Tricuspid regurgitation (TR) is common in patients with heart failure with preserved ejection fraction (HFpEF), but it has not been well characterized. We hypothesized that right atrial (RA) remodeling would be associated with TR in HFpEF, forming a type of atrial functional TR (AFTR). Echocardiography was performed in 328 patients with HFpEF. TR severity was defined using a guidelines-based approach. Ventricular functional TR was defined as the presence of right ventricular (RV) systolic pressure50 mm Hg or RV dilation, and the remaining patients were classified as having AFTR if they had RA dilation or tricuspid annular enlargement. RA dilation was common (78%) in the significant TR group (more than mild), exceeding the prevalence of RV dilation (32%), and RA dilation was correlated with tricuspid annular diameter and TR vena contracta width (r = 0.67 and r = 0.70, both p0.0001). Despite the absence of RV dilation and pulmonary hypertension, 38% of patients with significant TR had AFTR. Patients with AFTR and those with ventricular functional TR displayed higher heart failure hospitalization rates than those with nonsignificant TR (adjusted hazard ratios, 2.45 and 4.31; 95% confidence interval 1.12 to 5.35 and 2.44 to 7.62, p = 0.02 and p0.0001, respectively). In conclusion, TR in HFpEF is related to RA remodeling, and the presence of AFTR was associated with poor clinical outcomes. The current data highlight the importance of RA remodeling in the pathophysiology of TR in HFpEF. |
| Databáze: | OpenAIRE |
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